People-centred Approach to Addressing Antimicrobial Resistance in Human Health: WHO Core Package of Interventions to Support National Action Plans

"The first objective of the people-centred approach to addressing AMR [antimicrobial resistance] in human health is to shift the narrative of AMR away from a solely biological phenomenon (drug resistance) towards a people-centred narrative."

This document outlines the concept and content of the World Health Organization (WHO)'s people-centred approach to addressing antimicrobial resistance (AMR) in the human health sector. The proposed approach recognises and seeks to address the challenges and health system barriers people face when accessing health services to prevent, diagnose, and treat (drug-resistant) infections. It puts people and their needs at the centre of the AMR response and is designed to guide policymakers in taking action to mitigate AMR in line with a proposed package of 13 core interventions. Although primarily intended for national and subnational policymakers responsible for prioritising and leading AMR interventions in the human health sector through multisectoral National Action Plans (NAPs) on AMR, the secondary audience is health workers, communities, civil society groups, professional organisations, and the private sector involved in the development, implementation, and monitoring of NAPs on AMR in human health.

As explained in the publication, "AMR is a natural evolutionary response to exposure to antimicrobials that has been exacerbated by human behaviour, such as misuse and overuse in humans, agriculture and animal health, and environmental pollution. It has far-reaching implications, challenging our ability to treat common infections and perform life-saving surgery, and increases the risk of future pandemics due to resistant pathogens. Infections caused by resistant bacteria are among the leading causes of death for people of all ages: in 2019, bacterial AMR was directly responsible for 1.27 million deaths and contributed to 4.95 million deaths globally, with the highest burden estimated to be in western sub-Saharan Africa. These figures for mortality exceed those for HIV/AIDS, malaria and drug-susceptible tuberculosis in HIV-negative individuals and exceed earlier warnings." 

The 13 core interventions outlined in the document are based on a review of four pillars and two foundational steps that are critical to overcoming barriers faced by people and health systems in addressing AMR. The four pillars are:
 

1. Prevention of infections;
2. Access to essential health services;
3. Timely, accurate diagnosis; and
4. Appropriate, quality-assured treatment.

The pillars are supported by the two foundational steps: effective governance, awareness, and education; and strategic information through surveillance and research. Building and adding on to the objectives of the Global Action Plan on AMR, the 13 core interventions and accompanying priority actions are designed to address AMR in a programmatic manner that puts people, their needs, and equitable access to health services at the centre of the AMR response at four implementation levels: the community level (where a person presents to the healthcare system - e.g., home, school, informal care provided by a community health worker); the primary care level (the first point at which a person or a patient seeks health care delivered by suitably trained, qualified health workers); secondary and tertiary care level (specialised health care services); and at national and/or subnational level.

The 13 interventions, each outlined with a set of priority actions, are as follows: 
 

1. AMR advocacy, governance, and accountability in the human health sector in collaboration with other sectors;
2. AMR awareness-raising, education, and behaviour change of health workers and communities;
3. National AMR surveillance network to generate good-quality data to inform patient care and action on AMR;
4. Surveillance of antimicrobial consumption and use (AMC/U) to guide patient care and action on AMR;
5. AMR research and innovation, including behavioural and implementation science;
6. Universal access to WASH [water, sanitation, and hygiene] and waste management to mitigate AMR;
7. Implementation of IPC [infection prevention and control] core components to mitigate AMR;
8. Access to vaccines and expanded immunisation to manage AMR;
9. Health services for the prevention, diagnosis, and management of infectious disease syndromes - making them available and affordable for all;
10. Uninterrupted supply of quality-assured, essential health products for the prevention, diagnosis, and management of infectious disease syndromes;
11. Good-quality laboratory system and diagnostic stewardship to ensure clinical bacteriology and mycology testing;
12. Up-to-date evidence-based treatment guidelines and antimicrobial stewardship (AMS) programmes; and
13. Implementation of regulations to restrict non-prescription antimicrobial sales.

The development of the people-centred core package of AMR interventions was based on a review of the evidence and multidisciplinary expert opinion, complemented with feedback from a global online consultation and WHO's strategic and technical advisory group on antimicrobial resistance.